The embodiments herein relate generally to an insightful improvement in the protocol in the use of an intraoral discluder device for use in preventing migraine headaches and the treatment of temporomandibular disorders.
Research on migraines has helped to develop a better understanding of the causes of these headaches and treatment options. As stated in the Indian Academy of Neurology (“Ann Indian Acad Neurol. 2012 August; 15 (Suppl 1): S15-S22.), “ Migraine is a form of sensory processing disturbance with wide ramifications for central nervous system function, and while pain is used as the exemplar symptom, a brain-centered explanation provides a framework to understand all the manifestations of migraine . . . there is a form of central sensitization that may be classical central sensitization, or a form of dysinhibitory sensitization with dysfunction of descending modulatory pathways. Interestingly, the presence or absence of allodynia does not predict outcome from acute therapy in randomized controlled trials.”
Current medical prophylaxis for chronic migraine therefore is to limit or block all noxious efferents to the trigeminal sensory nucleus, with the intent of limiting central sensitization, as a sensitized trigeminal sensory nucleus is most susceptible to producing migraine attacks upon being stimulated.
U.S. Pat. No. 6,666,212 discloses an intraoral discluder device and method for preventing migraine and temporomandibular disorders. However, the understanding of the use of the intraoral discluder mistakenly assumes that muscle fatigue or spasm is a source of migraine pain when actually it is now best considered as a major contributing noxious input to the trigeminal sensory nucleus, thereby being a source of negative influence on central sensitization. In current on-going medical trials observing the use of the intraoral discluder compared to placebo devices, several patients have reported an increase in migraine frequency and pain with the discluder.
Further examination of these patients revealed two major oversights in migraine prevention that might have produced an unintended increase in central sensitization. First, the selection of a discluding device to be used on the maxillary incisors cannot be one of convenience for the provider. Practitioners commonly elect to provide a discluding device on the patient's maxillary teeth primarily because of the ease of fabrication and delivery, as the mandibular incisors are commonly less than ideally aligned, thereby making a discluding device on the mandibular incisors far more time consuming and complicated. However, the use of a maxillary device can allow for an opposing mandibular canine tooth to contact the maxillary retained device when the patient moves their mandible in an extreme right or left excursive from centered. A mandibular canine tooth contact on a maxillary-placed discluder device can allow for near maximal clenching intensity (Becker, JProsDent, July 1999, vol 82), thereby eliciting considerable noxious input, resulting in an increase in migraine frequency and intensity.
Second, providing a discluding device on either arch without addressing the thickness of the device and allowing it to be excessive between the maxillary and mandibular incisors can result in an excessive rotation of the mandibular condyle in a static position while clenching, that is, “over opened” during clenching events on the discluding device. In normal mastication, the rotation of the condyle is minimal during intense crushing of objects. If the thickness of the discluding device causes an excessive degree of rotation during clenching on the discluding device (“over opened”), the jaw joint can be strained, eliciting considerable noxious input, thereby increasing migraine frequency and intensity.
As such, there is a need in the industry for a method of using an intraoral discluder device that addresses the limitations of the prior art, which enhances migraine prevention and the treatment of temporomandibular disorders.